Authorization No. 132023-3B

Date: May 7, 2013

Please be advised that Peter Ajemian, M.D., has resigned his authorization to treat injured workers and to perform independent medical examinations in the New York State workers' compensation system effective March 4, 2013. Dr. Ajemian's authorization to treat injured workers and to perform independent medical examinations was previously suspended effective February 11, 2013. Dr. Ajemian's last known business address is 2280 Grand Avenue, Baldwin, New York, 11510.

Dr. Ajemian is prohibited from rendering treatment and care to injured workers and from performing independent medical examinations. Reports submitted by Dr. Ajemian for services rendered prior to February 11, 2013, are valid, but are invalid for any services rendered on or after that date. Requests to cross-examine Dr. Ajemian for services rendered prior to February 11, 2013, should not be denied due to his suspension or voluntary resignation.

Any questions regarding the authorized lists should be referred to the Medical Director's Office at 1 (800) 781-2362.